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The Ohio Supreme Court delivered a pair of blows to abortion clinics in Toledo and Cleveland on Tuesday.

In a 5-2 ruling, the high court upheld a state order shuttering Capital Care of Toledo, the northwest Ohio city's last abortion clinic, in a decision the facility is expected to appeal.

Justices found that the Ohio Department of Health acted within its rights in 2014 when it decided to shut down Capital Care of Toledo. Justices say the clinic violated a requirement because it no longer had a valid patient-transfer agreement.

Chief Justice Maureen O'Connor dissented in an opinion joined by former Justice William M. O'Neill, who submitted his opinion before resigning Jan. 26.

O'Connor wrote that Capital Care had complied with the state Health Department's rule on transfer agreements and that it was only abortion-related restrictions tucked into the state budget in 2013 that required the partnering hospital to be "local." She concluded those new laws were unconstitutional.

The restrictions mandated that clinics' long-required transfer agreements be with local hospitals, and also barred public hospitals from providing them. The University of Toledo Hospital ended its transfer arrangement with Capital Care about two months before the law was enacted.

Republican Attorney General Mike DeWine's office asked the high court during oral arguments in September to override lower court rulings and uphold the state's order. A lawyer for the clinic told the court that the state is trying to prevent women in northwestern Ohio from seeking legal abortions and is putting them at greater risk.

After the Republican-controlled state Legislature opted to outlaw transfer agreements with public hospitals, Capital Care went out of state, negotiating its required agreement with the University of Michigan Health System in Ann Arbor.

Legislators responded by passing a new law, this one setting a mileage limit on emergency care that Ann Arbor, at 52 miles away, was too far to meet.

In upholding the license revocation, Justice Terrence O'Donnell wrote for the majority: "In short, the evidence plainly established that the Ann Arbor agreement would not allow for the transfer of patients 'in the event of medical complications, emergency situations, and for other needs as they arise. ODH's determination that Capital Care did not comply with Ohio (administrative code) was supported by reliable, probative, and substantial evidence."

The second lawsuit, brought by Preterm of Cleveland, had sought to take on the constitutionality of the abortion-related restrictions in the 2013 budget bill more directly. The court ruled that the clinic lacked the legal standing to sue over the provisions.

Preterm had argued the changes imposed added administrative and caseload burdens on its operations that qualified the clinic to proceed with litigation. The lawsuit itself contended the bill violates the Ohio Constitution's single-subject rule. Justices found Preterm didn't demonstrate true or threatened harm from the regulatory changes.

Messages seeking comment were left Tuesday for attorneys representing the clinics.

The rulings come as Ohio has seen clinic closures across the state, as well as a decline in abortion procedures.

Abortion-rights advocates tie both to Republican-passed restrictions, some 20 signed by Republican Gov. John Kasich since he took office in 2011. (Kasich has also vetoed a stringent bill that would have limited abortions at the first detectable fetal heartbeat.)

Anti-abortion groups say abortions are declining for cultural reasons, including their own efforts against the procedure, and clinic closures are the result.

Mike Gonidakis, president of the Ohio Right to Life anti-abortion group, said in a statement Tuesday that the court "got it right." He called the rulings affirmation that "abortion should not be advanced at the expense of women's health and safety."